EASY DEBIT AUTHORIZATION FORM for auto payments to RAIN Network for monthly Internet service fees Name: Street Address: City/State/Zip: Phone: Username(s): AGREEMENT I hereby authorize the RAIN Network and their financial institutions to deduct my monthly service fees directly from my charge account using the following information: Bank / Branch of charge account: Number of Account: Expiration date if charge: Monthly fee I authorize for debit (choose one): ___ Individual Account ($18/month) ___ Business Account ($25/month) ___ Other ($_______/month) Description: I understand that this payment method will provide an easy payment method for my monthly RAIN service fees, and will commence 90 days from my current due date. Should I decide to discontinue RAIN service for any reason, I will notify RAIN in writing/by email at least 15 days before my account is due to terminate this payment agreement. Signature: Date: Send to RAIN, 1129 State St Ste A6, Santa Barbara CA 93101-2723 or fax to (805) 899-8698. DO NOT RETURN THE AUTO-DEBIT FORM VIA E-MAIL. This form must be sent with your original signature.